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Implementation of ICD-10 requires precision and accuracy

An EHR vendor product manager continues her discussion on why providers need to be serious about testing and budgeting when implementing ICD-10.

In this second installment of a two-part Q&A, Genice Hornberger, product manager for long-term care EHR vendor and service provider PointClickCare talked about what it takes to properly prepare for the coming Oct. 1 deadline for the implementation of ICD-10.

Among the issues she touched on is whether providers can relax knowing that there is a one-year "grace period" after Oct. 1 during which penalties won't be imposed for mistakes in the implementation of ICD-10.

The answer is a clear no. For one, the breathing period doesn't mean providers don't have to submit accurate codes.

Can you talk about best practices for budgeting for the implementation of ICD-10, or for training and implementation of ICD-10?

Genice Hornberger: Really with budgeting you have to think about not just the training costs, but some of the overhead costs that come along with it. Depending on the size of your organization, you might need a project manager to help with implementing. Is your organization going to do vendor testing with your payers. If so, that's going to take more staff time and you're going to allocate the resources for that and consider the cost associated with it. You also want to consider the training aspect, as well as coding and block out additional staff time that might be needed during that transition period. Most providers probably would have looked at this earlier in the year, hopefully. If not, since we're getting so close, they are going to really have to evaluate their budgets and make adjustments to get them through the next few months.

There's this new so-called grace period for ICD-10. Is that really going to help providers and vendors breathe a little easier? Or do you think it won't have much of an effect?

GeniceHornbergerGenice Hornberger

Hornberger: I think it's important to understand that even though there is this grace period, you still have to submit a valid ICD-10 code. The ICD-10 codes are broken into family groupings, and usually that family grouping is a three-character code. You will still need to provide a certain level of specificity within that family. So providers can't just assume, "Oh, if I just provide that family code, I'm good. It'll go through." The claim, if it's not to the required specificity, will get rejected. They do need to make sure they're doing that. It is not for all payers across the board either. Providers need to make sure they are following up with their other payers, insurance payers, managed care and Medicaid, to see [if] those payers [are] allowing for this grace period during the next 12 months as well.

What are some of the special issues involved in long-term care facilities and the changeover to ICD-10? How will caregivers and residents be affected by this? Also, in terms of the information that ICD-10 provides, people who support it, who are now pretty much in the majority, say it's going to give more accurate, detailed amounts of information. Do you think it's going to work out that way and help?

Even though there is this grace period, you still have to submit a valid ICD-10 code.
Genice HornbergerPointClickCare

Hornberger: Certainly the goal is that it will provide more information, more detailed information, research for expanding technology, and things like that. I think it will. In long-term care, I think there are some things to consider. A lot of times in long-term care, we have a coder that actually codes the diagnosis. It's not always the physician. A lot of the training that has been provided is really geared towards physicians and physician small practices. One of the challenges for long-term care facilities is to really understand how it's going to impact them and work through that roadmap on implementing it. Coders are really going to need to work with physicians, make sure physicians understand what this change means and how it's going to impact the long-term care facility. If long-term care facilities are on electronic health records, that might help to ease the impact. You might be able to add some transcription template that would prompt to help with the supporting documentation in certain areas.

Some people have been making fun of some of the codes in ICD-10 because they are so extensive, like getting injured while you're at the opera or getting struck by an orca whale. Do you think there are some pretty funny codes in there, or are most of them pretty solid?

One pixelWhat is ICD-10? SearchHealthIT's definition
helps explain.

Hornberger: There are some. One is your surfboard caught on fire while surfing. Obviously, a lot of those aren't going apply to the long-term care sector because those might be more applicable for an emergency room visit. There are definitely some quirky ones. They try to really have a complete listing of all the possible situations out there. Just because there's going to be 70,000 diagnoses, it doesn't mean long-term care facilities are going to use all of them. Even today with ICD-9, we have approximately what, 15,000 ICD-9 codes? You really only use a subset of those. With ICD-10, you're going to find there's going to be certain common ones that facilities are going to use, and those will be more common. You occasionally might have some outliers, but they'll really get used to the common ones for their practice.

Let us know what you think about the story; email Shaun Sutner, news and features writeror contact @SSutner on Twitter.

Next Steps

Physician poll shows doctors aren't prepared for ICD-10

Research report offers ICD-10 advice to healthcare CIOs

Health information management pros expect a reduction in coding duties

This was last published in August 2015

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